Received on December 21, 2006
Accepted on July 19, 2007

General Clinical Chemistry

Fetuin-A Is an Independent Predictor of Death after ST-Elevation Myocardial Infarction

¹ Department of Cardiology, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
² Department of Cardiology, Assistance Publique Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale 856, Pitie Salpetriere Hospital, Paris, France
³ Biochemistry Laboratory, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
⁴ Biochemistry Laboratory, Assistance Publique Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale 856, Pitie Salpetriere Hospital, Paris, France

^* To whom correspondence should be addressed. E-mail: lim.pascal.hmn{at}gmail.com.

Background: Fetuin-A inhibits inflammation and has a protective effect against myocardial ischemia. Its deficiency has been found to be associated with cardiovascular death in patients with end-stage renal failure disease. We investigated the association between plasma fetuin-A and clinical outcome after ST-elevation acute myocardial infarction (STEMI).

Methods: We measured fetuin-A in 284 consecutive patients with STEMI and correlated these data with the occurrence of death at 6 months (n = 25). We also measured fetuin-A in a control group and chose the 95th percentile as the cutoff to define abnormality.

Results: Patient mean (SD) age was 60 (14) years, and creatinine clearance was 83 (31) mL/min; 82% were men. Mean (SD) plasma fetuin-A concentrations at admission [188 (69) mg/L, P = 0.01] and at day 3 [163 (57) mg/L, P <0.0001] were lower in patients than in controls [219 (39) mg/L; 95th percentile 140 mg/L]. Fetuin-A <140 mg/L was observed in 20% of patients at admission vs 40% at day 3 (P <0.001). Fetuin-A concentrations did not correlate with peak cardiac troponin values but did correlate inversely with C-reactive protein (CRP) and NT-pro-brain natriuretic peptide (NT-proBNP). Fetuin-A <140 mg/L at admission (OR = 3.3, P = 0.03) and at day 3 (OR = 6.3, P = 0.002) was an independent correlate of death at 6 months, irrespective of NT-proBNP, CRP, or Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) risk score. Conversely, fetuin-A 140 mg/L was associated with an excellent survival rate [negative predictive value (NPV) = 97% overall], even in high-risk populations with CADILLAC risk score 6 (NPV = 90% in patients).

Conclusions: Fetuin-A is an important predictor of death at 6 months in STEMI patients independent of NT-proBNP, CRP, and CADILLAC risk score.